Stigmatisation of a patient co-infected with TB and HIV

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Abstract

The last few years have seen an increase in the infection rate not only of HIV but also TB.
The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of
infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub-
Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people
living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic
is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and
HIV exert increased pressure on health service delivery thus reflecting the serious problem
in the country with regard to health service delivery to people co-infected with TB and
HlV/AlDS.
Health service delivery is also hindered by negative attitudes of health workers that have
been reported towards people living with HIV/AIDS. They entertain a biased view of their
own risk, considering risk only from occupational exposure and denying the possibility of
infection in their private life. These attitudes of health workers decreases the quality of
care and support delivered to patient co-infected with TB and HIV. This result in people
not disclosing their illness even in cases were treatment is available like TB for the fear of
stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the
patient co-infected with TB and HIV. Therefore these patients tend to shy away from
health services and isolate themselves due to fear of being stigmatised twice.
The need to address TB and HIV together in the light of this dimension is urgent so as to
improve the utilization of the health services by people co-infected with Ti3 and HIV. The
purpose of this research was to explore and describe the experiences of patients co-infected
with TB and HIV regarding stigmatisation by the health workers, to explore and
describe the attitudes of health workers towards patients co-infected with TB and HIV, and
to formulate guidelines for health workers that will facilitate the health service utilization by
patients co-infected with TB and HIV in the Potchefstroom district.
The research was conducted in the Potchefstroom district in the North West province of
South Africa. A qualitative research design was used to explore and describe the
experiences of patients co-infected with TB and HIV regarding stigmatisation by the health
workers, and to explore and describe the attitudes of health workers toward co-infected
patients. A purposive voluntary sampling method was used to select participants who met
the set criteria. Two populations were used, that is the patients co-infected with TB and
HIV, and the health workers who were involved in their care. In depth unstructured
interviews were conducted with the patient population and semi structured interviews with
the health worker population using an interview schedule that was formulated from the
background literature. Data was captured on an audiotape, and transcribed verbatim.
Field notes were taken immediately after each interview. The researcher and a co-coder
did data analysis after data saturation was reached and a consensus was reached on the
categories that emerged.
From the findings of this research it appeared that there were general perceptions by the
patients co-infected with TB and HIV that indicated stigmatisation by the health workers.
This perceived stigmatisation was reported as being perpetrated by all categories of health
workers. Negative behaviours such as the health workers not having time for the patients
and being impatient were reported. Lack of sufficient knowledge was related to these
behaviours especially amongst lower categories or non-professional health workers. In
spite of the above, the researcher also observed that there was a limited number of health
workers who were still being perceived as committed and caring by the patients co-infected
with TB and HIV.
The researcher concluded that the relationship between the health workers and the
patients co-infected with TB and HIV was characterised by conflict. The health workers
seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse
alcohol, manipulative and not taking responsibility of their illness. These perceptions lead
the health workers to have a negative attitude towards these patients and occasionally
came across as unsympathetic towards them. On the other hand the researcher observed
that there were other health workers who did not present with negative behaviours towards
these patients and tried to understand the reasons for their sometimes-unacceptable
behaviours.
Recommendations are made for the field of nursing education, community health nursing
practice and nursing research with the formulation of guidelines for health workers so as to
facilitate the utilization of the health services by the patients co-infected with TB and HIV.
The guidelines are discussed under three main categories, namely guidelines for the
health workers to facilitate the utilization of the health services by the patients co-infected
with TB and HIV, guidelines to improve the utilization of the health services more efficiently
and adequately by the patients co-infected with TB and HIV, and guidelines to improve the
attitudes of the health workers towards the patients co-infected with TB and HIV with the
intention of improving the utilization of the health services by these patients.